Clinical Outcomes of Traction-Free Only Peripheral Hip Arthroscopy for Cam-Type Femoroacetabular Impingement

Abstract

Background/Objectives: Femoroacetabular impingement (FAI) is a common cause of hip pain and functional limitation in young and active patients. Conventional hip arthroscopy commonly requires traction and central-compartment access, which may contribute to traction-related neuropraxia and access-related chondrolabral injury. This study evaluated clinical outcomes after traction-free only peripheral hip arthroscopy (OPHA) for cam-type FAI with associated labral pathology. Methods: This retrospective cohort study included consecutive patients who underwent OPHA between November 2016 and May 2022 and had complete paired preoperative and postoperative outcome data. Outcomes included the visual analog scale (VAS) pain score, Hip Outcome Score activities of daily living subscale (HOS-ADL), Hip Outcome Score sport subscale (HOS-Sport), International Hip Outcome Tool-12 (iHOT-12), and Tegner activity score. Labral status was categorized as intact, repaired, or debrided. Paired outcomes were analyzed with the Wilcoxon signed-rank test. Results: Sixty-six patients were included (mean age, 38.9 +/- 10.8 years; 34 female). The mean postoperative follow-up was 5.7 years (range, 3.7-9.2 years). Labral status was intact in 32 patients, repaired in 23, and debrided in 11. Secondary intervention occurred in eight patients. In the overall cohort, VAS improved from 7.0 +/- 0.6 to 3.2 +/- 2.5 (p < 0.001), HOS-ADL from 59.1 +/- 1.9 to 79.2 +/- 17.5 (p < 0.001), HOS-Sport from 45.1 +/- 2.1 to 67.6 +/- 21.3 (p < 0.001), and iHOT-12 from 48.3 +/- 1.8 to 72.2 +/- 19.4 (p < 0.001). The Tegner activity score decreased from 5.2 +/- 0.7 to 4.3 +/- 1.4 (p < 0.001). Conclusions: Traction-free OPHA was associated with improvements in pain and hip-specific functional outcomes in selected patients with cam-type FAI and allowed individualized labral management without routine central-compartment distraction. The retrospective design and retrospective reconstruction of baseline PROMs in a subset of patients should be considered when interpreting the magnitude of the observed improvement.